To the Editor.—It was heartening to read of the conference on medical education for the 21st century sponsored by Ohio State University but disturbing to read some of the inferences therefrom reported in The Journal by Warren and colleagues.1 One example is their negative perception of the current trend toward shorter hospital stays: "This endangers our time-honored method of teaching students to learn by doing with real patients with real illnesses." Teaching hospitals can and must find ways to live with new fiscal realities while preparing future physicians to practice effectively in a cost-conscious era. They will not survive if they cannot learn to evaluate and treat patients as promptly as community hospitals do and if they are unwilling to place greater emphasis on ambulatory care.Some of the authors' remarks about family medicine are also unfortunate, but fortuitously they provide an opportunity to rebut some widely held